[Congressional Record Volume 152, Number 34 (Thursday, March 16, 2006)]
[Senate]
[Pages S2324-S2326]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SALAZAR (for himself, Mr. Thune, Mr. Akaka, Mr. Dorgan, 
        Mr. Pryor, Mr. Johnson, Mr. Burns, Ms. Murkowski, Mr. Thomas, 
        Mr. Baucus, Mr. Conrad, Mrs. Murray, Mrs. Lincoln, and Mr. 
        Burr):
  S. 2433. A bill to amend title 38, United States Code, to establish 
an Assistant Secretary for Rural Veterans in the Department of Veterans 
Affairs, to improve the care provided to veterans living in rural 
areas, and for other purposes; to the Committee on Veterans' Affairs.
  Mr. SALAZAR. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2433

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Rural Veterans Care Act of 
     2006''.

     SEC. 2. ASSISTANT SECRETARY FOR RURAL VETERANS.

       Section 308 of title 38, United States Code, is amended--
       (1) in subsection (a)--
       (A) by inserting ``(1)'' before ``There'';
       (B) by striking ``six'' and inserting ``seven''; and
       (C) by striking ``Each'' and inserting the following:
       ``(2) Each'';
       (2) by redesignating subsection (c) as paragraph (3) and 
     inserting such paragraph at the end of subsection (a);
       (3) by inserting after subsection (b) the following new 
     subsection:
       ``(c)(1) One of the Assistant Secretaries appointed under 
     subsection (a) shall be the Assistant Secretary for Rural 
     Veterans, who, under the direction of the Secretary, shall 
     formulate and implement all policies and procedures of the 
     Department that affect veterans living in rural areas.
       ``(2) The Assistant Secretary for Rural Veterans, under the 
     direction of the Secretary, shall perform the following 
     functions:
       ``(A) Except as otherwise expressly provided in this title, 
     carry out the provisions of this title and administer all 
     Department programs for providing care to veterans living in 
     rural areas who are eligible for services authorized under 
     this title.
       ``(B) Oversee and coordinate personnel and policies of the 
     Veterans Health Administration, the Veterans Benefits 
     Administration, the National Cemetery Administration, and 
     their respective subagencies, including Veterans Integrated 
     Service Networks, to carry out Department programs to the 
     extent such programs affect veterans living in rural areas.
       ``(C) Oversee, coordinate, promote, and disseminate 
     research into issues affecting veterans living in rural areas 
     in cooperation with the medical, rehabilitation, health 
     services, and cooperative studies research programs, the 
     Office of Policy and the Office of Research and Development 
     of the Veterans Health Administration, and the centers 
     established in section 7329.
       ``(D) Ensure maximum effectiveness and efficiency in 
     providing services and assistance to eligible veterans under 
     the programs described in subparagraph (A), after 
     consultation with appropriate representatives of the Centers 
     for Medicare and Medicaid Services, the Indian Health 
     Service, and the Office of Rural Health Policy of the 
     Department of Health and Human Services, the Social Security 
     Administration, the Department of Labor, the Department of 
     Agriculture (acting through the Under Secretary for Rural 
     Development), and other Federal, State, and local government 
     agencies.
       ``(E) Work with all personnel and resources of the 
     Department to develop, refine, and promulgate policies, best 
     practices, lessons learned, and innovative and successful 
     programs to improve care and services for rural veterans.
       ``(F) Perform such other functions and duties as the 
     Secretary considers appropriate.
       ``(3) The Secretary shall ensure that the Assistant 
     Secretary for Rural Veterans has the budget, authority, and 
     control necessary for the development, approval, 
     implementation, integration, and oversight of policies, 
     procedures, processes, activities, and systems of the 
     Department relating to the care of rural veterans. The 
     Secretary shall identify a Rural Veterans Coordinator in each 
     Veterans Integrated Service Network, who shall report to the 
     Assistant Secretary for Rural Veterans and coordinate the 
     functions authorized under this subsection within such 
     network.
       ``(4) The Assistant Secretary for Rural Veterans, under the 
     direction of the Secretary, shall supervise the employees of 
     the Department who are responsible for implementing the 
     policies and procedures described in paragraph (1).''; and
       (4) in subsection (d)--
       (A) in paragraph (1)--
       (i) by striking ``18'' and inserting ``19''; and
       (ii) by adding at the end the following: ``One of the 
     Deputy Assistant Secretaries appointed under this paragraph 
     shall be the Deputy Assistant Secretary for Rural Veterans, 
     who shall perform such functions as the Assistant Secretary 
     for Rural Veterans prescribes.'';
       (B) in paragraph (2), by inserting ``or, in the case of the 
     Deputy Assistant Secretary for Rural Veterans, comparable 
     service in a management position in the Armed Forces'' after 
     ``Secretary''.

     SEC. 3. RESPONSIBILITIES OF ASSISTANT SECRETARY FOR RURAL 
                   VETERANS.

       (a) Demonstration Projects.--
       (1) In general.--The Assistant Secretary for Rural 
     Veterans, appointed under section 308 of title 38, United 
     States Code, shall carry out demonstration projects to 
     examine alternatives for expanding care in rural areas, 
     including--
       (A) establishing a partnership between the Department of 
     Veterans Affairs and the Centers for Medicare and Medicaid 
     Services of the Department of Health and Human Services to 
     coordinate care for rural veterans conducted at critical 
     access hospitals (as designated or certified under section 
     1820 of the Social Security Act (42 U.S.C. 1395i-4));
       (B) establishing a partnership between the Department of 
     Veterans Affairs and the Department of Health and Human 
     Services to coordinate care for rural veterans conducted at 
     community health centers;
       (C) expanding the use of fee basis care through which 
     private hospitals, health care facilities, and other third-
     party providers are reimbursed for providing care closer to 
     the homes of veterans living in rural areas, as authorized 
     under section 7405(a)(2); and

[[Page S2325]]

       (D) expanding coordination between the Department of 
     Veterans Affairs and the Indian Health Service to expand care 
     for Native American veterans.
       (2) Geographic distribution.--The Assistant Secretary for 
     Rural Veterans shall ensure that the demonstration projects 
     authorized under paragraph (1) are located at facilities that 
     are geographically distributed throughout the United States.
       (3) Report.--Not later than two years after the date of 
     enactment of this Act, the Assistant Secretary for Rural 
     Veterans shall submit a report on the results of the 
     demonstration projects conducted under paragraph (1) to--
       (A) the Committee on Veterans Affairs of the Senate;
       (B) the Committee on Appropriations of the Senate;
       (C) the Committee on Veterans Affairs of the House of 
     Representatives; and
       (D) the Committee on Appropriations of the House of 
     Representatives.
       (b) Policy Revisions.--Not later than one year after the 
     date of enactment of this Act, the Assistant Secretary for 
     Rural Veterans shall--
       (1) reevaluate directives 5005 and 5007 of the Department 
     of Veterans Affairs and other guidance and procedures related 
     to the use of fee basis care nationwide; and
       (2) revise established policies to--
       (A) provide stronger guidance to units of the Department of 
     Veterans Affairs; and
       (B) strengthen the use of fee basis care to extend health 
     care services to rural and remote rural areas.
       (c) Reports to Congress.--The Secretary of Veterans Affairs 
     shall submit to Congress, in conjunction with the documents 
     submitted in support of the President's budget for each 
     fiscal year, an assessment of the implementation during the 
     most recently completed fiscal year of the provisions of this 
     Act and the amendments made by this Act.

     SEC. 4. PILOT PROGRAM ON ENHANCED ACCESS TO HEALTH CARE FOR 
                   VETERANS IN HIGHLY RURAL AND GEOGRAPHICALLY 
                   REMOTE AREAS.

       (a) Pilot Program.--
       (1) In general.--The Secretary of Veterans Affairs shall 
     conduct a pilot program to evaluate the feasability and 
     advisability of utilizing various means to improve the access 
     of veterans who reside in highly rural or geographically 
     remote areas to health care services referred to in 
     subsection (d).
       (2) Provision of services under pilot program.--In 
     conducting the pilot program, the Secretary shall provide 
     health care services referred to in subsection (d) to 
     eligible veterans who reside in highly rural or 
     geographically remote areas in the geographic service regions 
     selected for purposes of the pilot program utilizing the 
     contract authority of the Secretary under section 1703 of 
     title 38, United States Code, and such other authorities 
     available to the Secretary as the Secretary considers 
     appropriate for purposes of the pilot program.
       (b) Eligible Veterans.--A veteran is an eligible veteran 
     for purposes of this section if the veteran--
       (1) has a service-connected disability; or
       (2) is enrolled in the veterans health care system under 
     section 1705 of title 38, United States Code.
       (c) Highly Rural or Geographically Remote Areas.--An 
     eligible veteran resides in a highly rural or geographically 
     remote area for purposes of this section if the veteran--
       (1) resides in a location that is more than 60 miles 
     driving distance from the nearest Department of Veterans 
     Affairs health care facility; or
       (2) in the case of an eligible veteran who resides in a 
     location that is less than 60 miles driving distance from 
     such a facility, experiences such hardship or other 
     difficulties (as determined pursuant to regulations 
     prescribed by the Secretary for purposes of this section) in 
     travel to the nearest Department of Veterans Affairs health 
     care facility that such travel is not in the best interests 
     of the veteran.
       (d) Health Care Services.--The health care services 
     referred to in this section are--
       (1) acute or chronic symptom management;
       (2) nontherapeutic medical services; and
       (3) any other medical services jointly determined 
     appropriate for an eligible veteran for purposes of this 
     section by the physician of the department responsible for 
     primary care of such eligible veteran and the director of the 
     Veterans Integrated Service Network concerned.
       (e) Areas for Conduct of Pilot Program.--
       (1) In general.--The pilot program shall be conducted in 3 
     of the geographic service regions of the Veterans Health 
     Administration (referred to as Veterans Integrated Service 
     Networks) selected by the Secretary for purposes of the pilot 
     program.
       (2) Selection.--In selecting geographic service regions for 
     the purposes of the pilot program, the Secretary, based on 
     the recommendations of the Assistant Secretary for Rural 
     Veterans, shall select from among the Veterans Integrated 
     Service Networks that have a substantial population of 
     veterans who reside in highly rural or geographically remote 
     areas.
       (f) Period of Pilot Program.--The pilot program shall be 
     conducted during fiscal years 2007, 2008, and 2009.
       (g) Funding for Pilot Program.--
       (1) In general.--For each fiscal year during which the 
     pilot program is conducted, the Secretary shall allocate for 
     the pilot program an amount equal to 0.9 percent of the total 
     amount appropriated for such fiscal year for medical 
     services.
       (2) Timing of allocation.--The allocation under paragraph 
     (1) for a fiscal year shall be made before any other 
     allocation of funds for medical care is made for such fiscal 
     year, and any remaining allocation of funds for medical care 
     for such fiscal year shall be made without regard to the 
     allocation under subsection (a) in such fiscal year.
       (h) Report to Congress.--Not later than February 1, 2009, 
     the Secretary shall submit to Congress a report on the pilot 
     program. The Secretary shall include in the report such 
     recommendations as the Secretary considers appropriate 
     concerning extension of the pilot program or other means to 
     improve the access of veterans who reside in highly rural or 
     geographically remote areas to health care services referred 
     to in subsection (d).

     SEC. 5. TRAVEL REIMBURSEMENT FOR VETERANS RECEIVING TREATMENT 
                   AT FACILITIES OF THE DEPARTMENT OF VETERANS 
                   AFFAIRS.

       Section 111 of title 38, United States Code, is amended--
       (1) in subsection (a)--
       (A) by striking ``subsistence),'' and inserting 
     ``subsistence at a rate equivalent to the rate provided to 
     Federal employees under section 5702 of title 5),''; and
       (B) by striking ``traveled,'' and inserting ``(at a rate 
     equivalent to the rate provided to Federal employees under 
     section 5704 of title 5),'';
       (2) by striking subsection (g); and
       (3) by redesignating subsection (h) as subsection (g).

     SEC. 6. CENTERS FOR RURAL HEALTH RESEARCH, EDUCATION, AND 
                   CLINICAL ACTIVITIES.

       (a) In General.--Subchapter II of chapter 73 of title 38, 
     United States Code, is amended by adding at the end the 
     following new section:

     ``Sec. 7329. Centers for rural health research, education, 
       and clinical activities

       ``(a) Establishment of Centers.--The Assistant Secretary 
     for Rural Veterans shall establish and operate not less than 
     one and not more than five centers of excellence for rural 
     health research, education, and clinical activities, which 
     shall--
       ``(1) conduct research on rural health services;
       ``(2) allow the Department to use specific models for 
     furnishing services to treat rural veterans;
       ``(3) provide education and training for health care 
     professionals of the Department; and
       ``(4) develop and implement innovative clinical activities 
     and systems of care for the Department.
       ``(b) Geographic Dispersion.--The Assistant Secretary for 
     Rural Veterans shall ensure that the centers authorized under 
     paragraph (1) are located at health care facilities that are 
     geographically dispersed throughout the United States.
       ``(c) Selection Criteria.--The Assistant Secretary for 
     Rural Veterans may not designate a health care facility as a 
     location for a center under this section unless--
       ``(1) the peer review panel established under subsection 
     (d) determines that the proposal submitted by such facility 
     meets the highest competitive standards of scientific and 
     clinical merit; and
       ``(2) the Assistant Secretary for Rural Veterans determines 
     that the facility has, or may reasonably be anticipated to 
     develop--
       ``(A) an arrangement with an accredited medical school to 
     provide residents with education and training in care for 
     rural veterans;
       ``(B) the ability to attract the participation of 
     scientists who are capable of ingenuity and creativity in 
     health care research efforts;
       ``(C) a policymaking advisory committee, composed of 
     appropriate health care and research representatives of the 
     facility and of the affiliated school or schools, to advise 
     the directors of such facility and such center on policy 
     matters pertaining to the activities of such center during 
     the period of the operation of such center; and
       ``(D) the capability to effectively conduct evaluations of 
     the activities of such center.
       ``(d) Panel to Evaluate Proposals.--(1) The Assistant 
     Secretary for Rural Veterans shall establish a panel to--
       ``(A) evaluate the scientific and clinical merit of 
     proposals submitted to establish centers under this section; 
     and
       ``(B) provide advice to the Assistant Secretary for Rural 
     Veterans regarding the implementation of this section.
       ``(2) The panel shall review each proposal received from 
     the Assistant Secretary for Rural Veterans and shall submit 
     its views on the relative scientific and clinical merit of 
     each such proposal to the Assistant Secretary.
       ``(3) The panel established under paragraph (1) shall be 
     comprised of experts in the fields of public health research, 
     education, and clinical care.
       ``(4) Members of the panel shall serve as consultants to 
     the Department for a period not to exceed two years.
       ``(5) The panel shall not be subject to the Federal 
     Advisory Committee Act.
       ``(e) Funding.--(1) There are authorized to be appropriated 
     such sums as may be necessary for the support of the research 
     and education activities of the centers established pursuant 
     to subsection (a).
       ``(2) The Assistant Secretary for Rural Veterans shall 
     allocate such amounts as the

[[Page S2326]]

     Under Secretary for Health determines to be appropriate to 
     the centers established pursuant to subsection (a) from funds 
     appropriated for the Medical Care Account and the Medical and 
     Prosthetics Research Account.
       ``(3) Activities of clinical and scientific investigation 
     at each center established under subsection (a)--
       ``(A) shall be eligible to compete for the award of funding 
     from funds appropriated for the Medical and Prosthetics 
     Research Account; and
       ``(B) shall receive priority in the award of funding from 
     such account to the extent that funds are awarded to projects 
     for research in the care of rural veterans.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 73 of title 38, United States Code, is 
     amended by inserting after the item relating to section 7328 
     the following new item:

``7329. Centers for rural health research, education, and clinical 
              activities.''.
                                 ______